Beat Your Sneaky Leak

Stay dry with these nonsurgical therapies for stress incontinence

Uh-oh. You're running errands in a crowded mall and suddenly feel a sneeze coming on. You hesitate to let loose, knowing that any sort of pressure will make you leak. (You know, urine.) We're talking about stress urinary incontinence, or SUI, and as anyone with it already knows, it can profoundly affect your quality of life. Here's what you need to know.

SUI comes down to a battle between opposing forces, with only one winner. A force—maybe a cough or a sneeze—creates abdominal pressure, which must duke it out with the pressure created by the urine in your bladder. If you have SUI, your bladder wins the battle, and urine leaks out. The probable cause? A weakened pelvic floor. A layer of muscle and connective tissue supports the bladder and urethra (which transports urine), explains urogynecologist W. Conrad Sweeting, MD, an associate clinical professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco. "Pregnancy and childbirth can disrupt this support system, causing you to leak urine when abdominal pressure increases." Other potential SUI culprits include:

Menopause "Lower estrogen levels make the connective tissue less elastic, causing it to tear more easily," says Jill Maura Rabin, MD, head of urogynecology at Long Island Jewish Medical Center in New Hyde Park, NY.

Asthma "Anything that causes you to cough hard can weaken the pelvic floor," says Dr. Sweeting. (That includes smoking!)

Heredity "You inherit the quality of the collagen in these tissues," Dr. Rabin says.

Excess weight. "Women with a body mass index (BMI) of 27 or more are more susceptible to stress incontinence," says Dr. Rabin. "That weight is tough on the muscles that help support your bladder and urethra."

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What's a Woman to Do?

The decision to seek treatment for SUI lies with you. "It's not how much urine you leak or how often that should prompt you to make a doctor's appointment, but whether the problem affects your quality of life," says Dr. Sweeting. "Ideally, talking to your doctor before it affects you may help you avoid surgery."

Conservative Therapies

Most conservative treatments help you tone your pelvic muscles, and they work well if you start them early. "If all women would start strengthening these muscles when they're young, about half of the surgeries for SUI could be avoided," says Dr. Rabin.

Practice your Kegels. These exercises strengthen the muscles that help control urine flow. Here's what it feels like to do a Kegel: The next time you urinate, contract your pelvic muscles to try to stop the flow of urine. The muscles you use are the same you'll want to strengthen with the Kegels. Holding back urine is not the way to practice Kegels. It's just to identify the muscles because Kegels are easy to do incorrectly. If you can't readily identify the muscles that help you urinate, ask your doctor for training. Don't keep practicing by holding back urine. A standard regime of Kegels would be to do a set of 5 to 10, three times a day, and hold each contraction for 5 seconds. After each contraction, relax to a count of 10. However, if a rigid schedule doesn't work for you, Dr. Sweeting suggests that you do your Kegels, as many as you can, whenever you think of it. (Here's the right way to do Kegel exercises)

Let freedom ring. Incontinence rings, prescribed by your doctor, are designed with a knob that sits under the urethra. When you cough, sneeze, or run, the urethra closes on the knob, preventing leaks. You can insert and remove this ring yourself.

Lift weights. Vaginal weights come in sets of five progressively weighted cones. You insert the lightest cone into your vagina first. "The muscles that hold the cones inside your body are the same muscles that Kegels work," says Dr. Rabin. Vaginal weights are available without a prescription, but can be costly. Your doctor can help you decide if they are right for you.

Lose weight. Shedding those extra pounds will help take some of the strain off an already weakened pelvic floor, says Dr. Rabin.

Zap the problem. Electrical stimulation can be used to make muscles stronger. Your doctor or nurse practitioner inserts an electrode into your vagina to stimulate the same muscles that Kegels do.

Dispense with pads. "Our goal is to get people out of diapers," says Dr. Sweeting. But while you're undergoing treatment, you may need some extra protection. "Today's incontinence products are very thin and discreet," he adds. "No one will even know you're wearing them."

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Drug Options

Lying somewhere between behavioral and surgical treatments for SUI are drugs that may help you gain more control over your bladder.

Look over-the-counter. Some women use the decongestant pseudoephedrine to help keep the muscles around the urethra closed. Because all drugs have side effects, though, be sure to talk to your doctor before using pseudoephedrine, because it can cause high blood pressure or rapid heartbeat.

Consider estrogen therapy. "Estrogen improves the tone of the urethral muscles, which can boost bladder control," says Dr. Rabin. "I prescribe local estrogen therapy in the form of vaginal rings, creams, or pills to some of my patients."

Ask about prescription medications. There are a number of prescription medications used to calm an overactive bladder, so they may be helpful for urge incontinence, according to the Mayo Clinic. Some of the drugs that fall under this category, include oxybutynin, tolterodine, darifenacin, fesoterodine, solifenacin, and trospium.

Surgical Options

If conservative treatments don't correct SUI, you may want to talk to your doctor about surgery. The aim of surgery is to support the area under the urethra near the bladder, by creating a backstop or "sling" to support it. The type of surgery you have depends on your doctor's experience and the severity of the problem. Both Drs. Sweeting and Rabin suggest that you see either a urogynecologist or a urologist. If surgery is done properly, the cure rate is around 85 to 95%, they say.